Sutureless vascular end-to-side anastomosis: an in-vivo test of a percutaneous concept in the animal model

Abstract

To test a percutaneous concept for creation of a sutureless terminolateral vascular anastomosis in vivo. By creating sideholes into the middle portion of a stent and a stent graft, both implants could be arranged in a Y-shaped configuration. An arteriovenous shunt was created in 3 sheep between the left carotid artery and the left external jugular vein. A stent graft was partially inserted into the venous lumen. Axial venous patency was restored by placing a stent through the sidehole into the graft lumen from an upstream puncture site. Graft patency was maintained by placing the sidehole of the stent at the bridging point between stent graft and stent with no stent struts crossing. Arterial end-to-end anastomosis was performed by retrograde placement of a stent graft into the arterial lumen. Both anastomoses were connected by a silicone tube. In all cases, a venous end-to-side anastomosis was created that was blood-tight and safely secured into the vascular lumen. Y-shaped configuration of stent and stent grafts through sideholes allows creation of sutureless end-to-side anastomoses in vivo.